The underprivileged, developing country child: environmental contamination and growth failure revisited.

A major public health challenge to human populations in developing countries is poor linear growth and failure to maximize genetic potential in final adult stature. It is now clear that this process occurs in early life, and neither genetics nor dietary intake, or both, is the complete determinant. We suggest that a situation similar to the phenomenon of impaired growth of poultry and livestock reared under unsanitary conditions occurs in children from underprivileged countries. Recent advances in cell biology and immunology suggest that the intermittent or continuous activation of the acute-phase response with the consequent mediation of catabolic and antitrophic metabolic processes is responsible for the antibiotic-responsive growth impairment of chicks raised in unhygienic environments. Ongoing epidemiological studies in poor Third World children provide evidence for a prevalence of acute-phase response activation in the absence of overt clinical signs. The consequences of this immunostimulation of the growing infant or toddler could represent an important additional factor in the failure of children in developing countries to manifest adequate growth and to achieve their genetic potential for adult stature.